Wholesale Registration Form

Thank you for submitting your form!

We appreciate your interest and will review your information as soon as possible.

Our team is dedicated to providing excellent customer service, and we will do our best to respond promptly.

Wholesale Registration

Submit the application by filling in this form.

Company / Business Name *

ABN *

Title

Position

First Name *

Last Name *

Business Email *

Business Phone *

Type of Business *

How did you hear about us? *

What percentage of your clientele are children in your weekly appointments? *

What other children's brands do you stock? *

Street Address *

Suburb *

Postal code *

Country *

State *

Website

Facebook

Instagram

TikTok

Yes, I agree to receive marketing emails.

I have read and accepted the terms and conditions.

I have read and accepted the eekoloks® Reseller Policy.